Hirshberg Matthew J, Davidson Richard J, Velarde Arrisueño Luciana B, Olvera Puentes José Miguel, Bardalez Ximena Medina, Gonzalez Byron S, Goldberg Simon B, Chernicoff Leandro I
Center for Healthy Minds, University of Wisconsin-Madison, Madison.
Department of Psychology, University of Wisconsin-Madison, Madison.
JAMA Intern Med. 2025 Aug 18. doi: 10.1001/jamainternmed.2025.3888.
High levels of health care professional (HCP) distress portend negative consequences for HCPs and health systems.
To evaluate whether a 13-week digital well-being training could improve Mexican HCP distress and well-being.
DESIGN, SETTING, AND PARTICIPANTS: This 2-arm randomized clinical trial was conducted between March 2023 and March 2024 with 13-week postintervention and 37-week follow-up end points. Participants included 2315 adults with no previous well-being training experience who worked in 762 participating health care facilities across 7 Mexican states. Participants were randomly assigned (1:1) using stratified permuted blocks to well-being training or wait-list control. Outcomes assessors and study data analyst were masked to condition assignment. Assessments and intervention were conducted remotely.
The digital well-being training consisted of nine 2-hour zoom sessions and 13 weeks of the Healthy Minds Program smartphone app structured on the premise that well-being skills can be strengthened through psychoeducation and contemplative practice.
The primary prespecified outcomes were participant-reported distress (aggregate of z-scored National Institutes of Health Toolbox perceived stress, and Perceived Stress and Patient Reported Outcomes Measurement Information System anxiety and depression scales; mean = 0, SD = 1) and the World Health Organization-5 measure of well-being (range 0-25).
Among 2315 participants, 1693 (73.1%) identified as female; 778 (33.4%) nurses, 736 (31.7%) physicians, 187 (8.1%) psychologists, 183 (7.9%) administrators, 154 (6.7%) dentists, 75 (3.2%) social workers, 64 (2.8%) nutritionists, 55 (2.4%) laboratory technicians, 40 (1.7%) physical therapists, 29 (1.3%) health promoters, and 8 (<0.1%) other health professionals; the mean (SD) age was 34.7 (11.4) years. Relative to control, in intention-to-treat analyses the intervention group reported 13-week reductions in distress (adjusted standardized mean difference [SMD], -0.24; 95% CI, -0.32 to -0.16) and increases in well-being (adjusted SMD, 0.27; 95% CI, 0.18 to 0.35) that increased in magnitude at 37-week follow-up (distress, -0.36; 95% CI, -0.44 to -0.28; well-being, 0.42; 95% CI, 0.34 to 0.50). Primary outcomes were robust in sensitivity analyses. There were 10 adverse events (intervention: 0.05% [6 of 1157]; control: 0.04% [4 of 1158]).
This randomized clinical trial found that scalable digital well-being training modestly improved Mexican HCP distress and well-being compared with a wait-list condition. As HCPs are essential to public health and report high levels of distress that interfere with their ability to provide optimal care, well-being training may be an avenue to better supporting HCPs.
ClinicalTrials.gov Identifier: NCT05767970.
医护人员（HCP）的高度痛苦预示着对医护人员和卫生系统会产生负面后果。
评估为期13周的数字健康培训是否能改善墨西哥医护人员的痛苦状况和健康水平。
设计、地点和参与者：这项双臂随机临床试验于2023年3月至2024年3月进行，干预后为期13周，随访终点为37周。参与者包括2315名此前没有健康培训经验的成年人，他们在墨西哥7个州的762家参与研究的医疗机构工作。参与者使用分层排列块法以1:1的比例随机分配到健康培训组或等待名单对照组。结果评估者和研究数据分析师对分组情况不知情。评估和干预均通过远程方式进行。
数字健康培训包括9次每次2小时的Zoom会议以及13周的“健康心灵计划”智能手机应用程序，其构建前提是可以通过心理教育和冥想练习来增强健康技能。
预先设定的主要结局是参与者报告的痛苦程度（美国国立卫生研究院工具箱感知压力、感知压力以及患者报告结局测量信息系统焦虑和抑郁量表的z分数总和；均值 = 0，标准差 = 1）以及世界卫生组织-5健康水平测量指标（范围为0 - 25）。
在2315名参与者中，1693名（73.1%）为女性；778名（33.4%）为护士，736名（31.7%）为医生，187名（8.1%）为心理学家，183名（7.9%）为管理人员，154名（6.7%）为牙医，75名（3.2%）为社会工作者，64名（2.8%）为营养师，55名（2.4%）为实验室技术员，40名（1.7%）为物理治疗师，29名（1.3%）为健康促进者，8名（<0.1%）为其他卫生专业人员；平均（标准差）年龄为34.7（11.4）岁。在意向性分析中，与对照组相比，干预组报告在13周时痛苦程度降低（调整后的标准化均值差[SMD]，-0.24；95%置信区间，-0.32至-0.16），健康水平提高（调整后的SMD，0.27；95%置信区间，0.18至0.35），在37周随访时这种变化幅度增大（痛苦程度，-0.36；95%置信区间，-0.44至-0.28；健康水平，0.42；95%置信区间，0.34至0.50）。在敏感性分析中，主要结局结果稳健。共有10起不良事件（干预组：0.05%[1157例中的6例]；对照组：0.04%[1158例中的4例]）。
这项随机临床试验发现，与等待名单对照组相比，可扩展的数字健康培训适度改善了墨西哥医护人员的痛苦状况和健康水平。由于医护人员对公共卫生至关重要，且报告称高度痛苦会干扰他们提供最佳护理的能力，健康培训可能是更好地支持医护人员的一条途径。
ClinicalTrials.gov标识符：NCT05767970。
